Methods for diagnosing glomerulonephritis. Where to get a kidney ultrasound and be checked for glomerulonephritis in St. Petersburg

Kidney failure is the inability of the kidneys to remove waste from the blood. Initial signs are lower back or abdominal pain, nausea, vomiting, anemia, headaches. Later, urination is impaired - polyuria, oliguria or anuria. Leukocytes, bacteria, pus, blood, and protein may appear in the urine. Potassium, urea and creatinine are elevated in the blood.

In acute renal failure, kidney function sharply decreases. Main causes of acute renal failure: acute disorder hemodynamics; a sharp decline renal blood flow; acute bilateral obstruction urinary tract; toxic effects, less often – acute inflammatory process in the kidneys. The prognosis for acute renal failure depends on how quickly normal renal blood flow is restored. In acute renal failure, the kidney may be of normal size or enlarged, and the echogenicity of the parenchyma is often increased.

Chronic renal failure increases slowly and irreversibly. Common causes of chronic renal failure: infections, hypertension, vascular, congenital and hereditary diseases, toxic nephropathy, obstructive nephropathy. In the early stages of chronic renal failure there are no visible symptoms. Later, malaise, fatigue, decreased appetite, nausea, and arterial hypertension appear. Blood tests showed increased potassium, urea and creatinine. Due to low production of erythropoietin, anemia increases in diseased kidneys. With chronic renal failure, both kidneys are initially enlarged, but later become significantly smaller.

Important!!! High risk development of renal failure due to hydronephrosis, acute glomerulonephritis, papillary necrosis, renal artery stenosis, acute tubular necrosis, renal and other infections.

Acute and chronic glomerulonephritis on ultrasound

Acute glomerulonephritis is a bilateral inflammation of the glomeruli. Inflammation and sclerosis of the glomeruli impairs kidney function and can ultimately lead to kidney failure. Glomerulonephritis occurs as late complication throat infections. More common in children than in adults.

There may be complaints of recent fever, sore throat and joints, swelling of the face and ankles, cloudy urine, oliguria, high blood pressure. There is anemia in the blood, high urea and creatinine. In the urine there are red blood cells, protein, decreased speed glomerular filtration.

Acute glomerulonephritis often progresses to chronic glomerulonephritis. Irreversible sequential fibrosis of the glomeruli slowly occurs, the glomerular filtration rate decreases, urea and creatinine accumulate in the blood, and intoxication occurs. After 20-30 years, chronic glomerulonephritis leads to chronic renal failure and ultimately death.

Acute glomerulonephritis does not have any special ultrasound signs. You can notice a slight bilateral enlargement of the kidneys, the renal pyramids are well visualized, the echogenicity of the cortical zone is slightly increased. In chronic glomerulonephritis, ultrasound shows small, smooth, hyperechoic kidneys.

Necrosis of the renal papillae on ultrasound

The papillae are the cone-shaped tips of the kidney pyramids. They face the sinus and consist of the collecting ducts of the nephrons. See the structure of the kidney. Common reasons necrosis of the renal papillae

Impaired blood supply to the renal papilla due to edema, inflammation and sclerotic changes in the kidney;
Impaired urine outflow - urine accumulates in the pelvis, stretches it and compresses the kidney tissue;
Purulent-inflammatory processes in the renal medulla;
Impact of toxins on the renal parenchyma;
Impaired blood flow.

Necrosis of the papillae is usually bilateral. There are two forms of the disease: papillary and medullary form of necrosis of the pyramidal papillae. Patients with diabetes mellitus, sickle cell anemia are more susceptible to necrosis of the papillae of the renal pyramids. Women suffer from the disease 5 times more often than men.

Photo. A - Papillary necrosis papillae of the renal pyramids: 1 – the papilla is not changed, there is no sequestration; 2 - a canal is formed at the base of the papilla - this is the beginning of sequestration; 3 – after complete rejection of the papilla, the ring closes around it; 4 – the detached papilla has separated from the calyx into the pelvis, in its place is a small cavity with a jagged surface. B — Rejected papillary papilla. B - Medullary necrosis of the papillae of the renal pyramids: 1 - focal infarctions in the inner medullary zone; 2 – areas of necrotic tissue in the inner medullary zone, the mucous membrane of the papilla is not damaged; 3 – the mucous membrane at the apex of the papilla is damaged, part of the necrotic masses erupts into the calyx; 4 – the release of necrotic masses into the cup and pelvis continues, the cavity in the area of the pyramid expands. D — With medullary necrosis, in place of rejected necrotic masses, hypoechoic cavities (C) with uneven edge, which communicate with the CLK and are limited by the arcuate arteries. Easily confused with hydronephrosis. Please note that with hydronephrosis, all the calyces are enlarged, and with the medullary form of papillary necrosis, only a few stand out significantly from the general background.

Photo. Medullary necrosis of the papillae on ultrasound: A, B, C - Cavities are formed in the inner medullary zone of the kidneys, necrotic masses (arrows) are surrounded by a hypoechoic ring.

Complaints with necrosis of the papillae are nonspecific: fever, pain in the lower back or abdomen, high blood pressure (from renal ischemia), difficulty urinating. OAM includes proteinuria, pyuria, bacteriuria, hematuria, low specific gravity of urine. In 10% of patients, necrotic masses are excreted in the urine - gray, soft in consistency, layered in structure, often containing lumps of lime salts. This indicates a significant destructive process in the renal medulla. Often, fallen off papillae clog the calyces or ureters, which leads to obstruction and the development of hydronephrosis.

Photo. With papillary necrosis, hyper- or normechogenic formations without an acoustic shadow can be seen in the lumen of the ureters (UR), which impair the outflow of urine and lead to expansion of the distal sections - these are necrotic masses of rejected papillae (arrow). A - Upper third of the ureter. B - Middle third of the ureter. IN - Lower third ureter.

With timely treatment, the prognosis is favorable. After the removal of necrotic masses, the wound surface is epithelialized, and kidney function is restored. In the renal pyramids, round or triangular cysts form in place of the disappeared papillae. If the necrotic masses do not come off completely, then they calcify, and around renal sinus hyperechoic inclusions appear in the area of the papillae. In some cases, papillary necrosis can lead to death due to acute renal failure.

Photo. Papillary necrosis on ultrasound. A — A patient suffered necrosis of the pyramidal papillae after kidney transplantation. Cysts formed in place of the disappeared papillae. B — A patient who has suffered papillary necrosis has small cysts along the periphery of the sinus, which contain hyperechoic inclusions with an acoustic shadow. B — Papillary necrosis in a patient with sickle cell anemia: on ultrasound, in the medulla of the kidney there are multiple round and triangular cavities that communicate with the CLK; the pelvis is not dilated.

An important role in the development of glomerulonephritis is played by the body’s immunological resistance and its reactivity to pathogenic stimuli. With glomerulonephritis, the kidneys are affected, and the damaged cells become an antigen that the body perceives as foreign. This leads to the production of autoantibodies and maintenance of the chronic process. If there are chronic diseases upper respiratory tract, the process gets worse: streptococci and staphylococci play an important role in the development of the disease.

Latent, the most common form, has almost no clinical manifestations. There are slight changes in the urine. Such patients do not complain about their condition, but the disease gradually progresses.

Nephrotic form: decreased amount of protein in the blood (up to 4g%), increased cholesterol levels (more than 600mg), severe swelling. The kidneys work normally for the first few years after the onset of the disease, but then kidney failure develops. Gradually, the body self-poisons (uremia is recorded - accumulation of urea in the blood, disturbance of protein metabolism and acid-base balance).

differentiation of diagnosis (exclusion of pyelonephritis, kidney stones, renal amyloidosis, nephropathy, renal vein thrombosis, tumor, etc.);

urine tests, determination of disease activity (presence of hematuria, nephrotic syndrome, etc.);

identifying the degree of renal failure (if any) and searching for the causes of its occurrence;

Treatment of glomerulonephritis

It is important to understand that therapy is dangerous disease should be under the close supervision of a urologist-andrologist in a multidisciplinary medical center. Today you can get a 10% discount on the treatment of this disease if you make an appointment with a doctor online.

Treatment of chronic glomerulonephritis is complex and includes:

etiotropic therapy aimed at eliminating the cause of the disease;

Tests for glomerulonephritis

Timely diagnosis of glomerulonephritis and treatment are very important. They are able to prevent the severe course of this disease, which may lead to the development of chronic renal failure. The causes of glomerulonephritis often remain unclear. This is a collective definition of kidney diseases that are different in outcome, course and origin. At this time, only infectious signs have been well studied.

What is the disease?

Glomerulonephritis is an immunoinflammatory, immunoallergic group of diseases associated with damage to the vessels of the glomerular apparatus of both kidneys, changes in the structure of capillary membranes and impaired filtration. This leads to toxicity and excretion of protein components and blood cells necessary for the body through the urine. The disease occurs in people under 40 years of age and in children. The course of the disease is divided into the following types:

spicy;

subacute;

chronic;

focal nephritis.

Causes

Sinusitis can trigger the occurrence of glomerulonephritis.

This immune-inflammatory disease is possible after diphtheria, bacterial endocarditis, malaria, typhoid fever, various types of pneumonia. It may develop due to repeated administrations serum vaccines, under the influence medicines, alcohol, drugs, injuries and hypothermia, especially in a humid environment. The occurrence of glomerulonephritis in children is a consequence of past streptococcal infections, such as scarlet fever, inflammation of the tonsils (tonsillitis), otitis media, sinusitis and dental granuloma. It progresses quickly and in most cases is completely cured.

External symptoms

External signs of chronic glomerulonephritis depend on the course of the disease. There are two options: classic (typical) and latent (atypical). In the atypical variant, swelling is poorly manifested and moderate disturbances in urination are slightly visible. The classic version is associated with infectious diseases; its symptoms are pronounced:

swelling;

shortness of breath;

flakes and particles of blood in urine;

cyanosis of the lips;

significant weight gain;

slow heartbeat;

small volume of urine.

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Diagnostic procedures and tests for glomerulonephritis

Diagnosis of acute glomerulonephritis requires serious laboratory tests of blood and urine. With the rapid development of the disease and chronic form, a kidney biopsy may be needed to study the kidney tissue and immunological tests. An important factor in making a diagnosis are instrumental examinations And differential diagnosis. Timely diagnostic procedures facilitate the treatment of chronic glomerulonephritis.

First appointment

At the first appointment, the patient is examined for external signs of acute glomerulonephritis. Then, infectious diseases suffered 10-20 days before the examination, hypothermia, the presence of kidney diseases are determined, and blood pressure is measured. Since the visible symptoms are similar to those of acute pyelonephritis, the doctor prescribes additional diagnostic procedures to establish the correct diagnosis. The person is immediately sent to the hospital and is prescribed bed rest and diet.

Laboratory research

Laboratory tests help make an accurate diagnosis.

Laboratory diagnostics is an opportunity to diagnose correct diagnosis. Examination for glomerulonephritis includes a systematic study of the composition of urine and blood, which gives a correct idea of inflammatory processes in the body. For the study, a general urine test is prescribed, according to Nechiporenko and according to the Kakovsky-Addis method. Signs of acute glomerulonephritis:

proteinuria - increased content squirrel;

hematuria - the presence of blood particles in excess of the norm;

oliguria - a sharp decrease in the volume of excreted fluid.

Urine tests

Proteinuria is the main symptom of glomerulonephritis. This is due to a violation of filtration. Hematuria is an important symptom for diagnosis; it is a consequence of the destruction of glomerular capillaries. Along with proteinuria, it accurately shows the dynamics of the disease and the healing process. These symptoms persist for quite a long time, signaling an unfinished inflammatory process. Oliguria is observed on days 1-3, then it is replaced by polyuria. The persistence of this symptom for more than 6 days is dangerous.

Blood tests

At the onset of the disease, a blood test shows a moderate increase in nitrogen-containing protein processing products. Additionally, its composition changes due to high content water in the blood. An immunological two-level test is performed, which indicates the cause of the disease and excludes the diagnosis of acute pyelonephritis. The first level checks for gross violations in the immune system, the second is carried out to clarify the detected changes.

Instrumental diagnostics

This type of diagnosis is carried out using special medical equipment. Examination using technology simplifies the procedure for diagnosing glomerulonephritis in children because it is painless. X-rays are used to study the course of the disease, treatment, and identify dangerous changes in the kidney tissue. ultrasound scanning, computed tomography, various methods of endoscopy.

Ultrasound diagnostics

Chronic glomerulonephritis on ultrasound can be distinguished from other nephrotic diseases by the following characteristics: sharp tissue thickening, increased volume with smooth and clear contours, diffuse changes glomeruli, connective tissues and tubules. These indicators differ from the signs of acute pyelonephritis, which simplifies the differential diagnosis. Ultrasound examination shows the accumulation of fluid in the organs, which also determines acute glomerulonephritis.

Kidney biopsy

Nephrobiopsy or kidney biopsy is a procedure in which a small piece of kidney tissue is pinched off for examination. This method accurately classifies immune complexes, which makes it possible to determine the type, form, cause, nature of changes and severity of the disease. The difficult definition of chronic glomerulonephritis makes a biopsy an indispensable examination.

Differential diagnosis

Differential diagnostics works by the method of exclusion. A doctor, having a mosaic of symptoms and laboratory tests, using a combination of logical and diagnostic algorithms, can distinguish between similar diseases. Acute and chronic glomerulonephritis is similar in symptoms to many diseases. This makes differential diagnosis more complicated. We will have to exclude acute pyelonephritis, nephropathy in diabetes, tuberculosis and tumors of the kidneys or urinary tract and many other nephrosis.

Chronic glomerulonephritis. Forms of chronic glomerulonephritis, symptoms, diagnosis and treatment of the disease.

FAQ

Glomerulonephritis is a disease in which kidney tissue is damaged. With this disease, the renal glomeruli, in which primary filtration of blood occurs, are primarily affected. Chronic course of this disease gradually leads to the loss of the kidneys’ ability to perform their function - to cleanse the blood of toxic substances with the development of renal failure.

What is the glomerulus and how do the kidneys work?

The blood entering the kidneys through the renal artery is distributed inside the kidney into the smallest vessels, which flow into the so-called renal glomerulus.

What is a renal glomerulus?

But in addition to toxic substances, many useful and vital substances are dissolved in this urine - electrolytes, vitamins, proteins, etc. In order for everything useful for the body to return to the blood, and everything harmful to be excreted in the final urine, primary urine passes through a system of tubes (loop of Henle, renal tubule). It undergoes constant processes of transition of substances dissolved in primary urine through the wall of the renal tubule. Having passed through the renal tubule, primary urine retains toxic substances in its composition (which need to be eliminated from the body) and loses those substances that cannot be eliminated.

Features of glomerulonephritis in children

Glomerulonephritis or glomerular nephritis is inflammation of the glomerular apparatus of the kidney of an infectious or autoimmune nature. Glomerulonephritis in children ranks second among all acquired diseases of the renal system, ahead only of pyelonephritis. In almost eighty percent of cases, the acute form of this pathology leads to the development of heart complications.

Functions of the organ

Kidneys play a huge role in proper operation body. Their main function is the release of metabolic products. They also carry out carbohydrate and protein metabolism, are responsible for the production of blood elements, regulate blood pressure, maintain acid-base and electrolyte balance in organism.

Causes of glomerulonephritis

The reasons for the development of this disease lie in the development of inflammation of an immune nature; complexes are formed due to the presence of an exciting factor. This very factor can act as a factor.

Streptococcus bacteria. Poststreptococcal glomerulonephritis is the most common. As a rule, three weeks after tonsillitis, pharyngitis, scarlet fever, symptoms of an inflammatory process in the glomeruli of the kidney occur.

viral agents;

bee and snake venom;

post-vaccination glomerulonephritis;

other bacterial microorganisms.

The triggering mechanisms may be the following:

cold or high temperature;

stress;

overheat.

When an infectious agent enters the body, it is not destroyed, but forms a compound that attaches to the glomeruli. The child’s immune system views this compound as foreign, so it begins to destroy kidney tissue, forming inflammation.

As a result of this, the filtration mechanisms of the kidney are disrupted, and all the final metabolic substances accumulate in the body.

Types of glomerulonephritis

Based on the presence of swelling, hypertension and changes in the urine, the following classification exists:

Acute glomerulonephritis in children can have the following types:

nephritic syndrome;

mixed look;

nephrotic syndrome;

isolated urinary syndrome.

Chronic glomerulonephritis is divided into:

nephrotic form;

hematuric form;

mixed form.

Acute form

Symptoms of glomerulonephritis in children are very diverse. If we're talking about about the nephritic type of the disease, then the onset of the disease will be rapid, but with the nephrotic type it is slow.

Nephritic syndrome is characterized by swelling of the face, they feel dense to the touch, and are difficult to get rid of. The child also develops arterial hypertension, which causes pain in the back of the head, vomiting, and nausea. Protein impurities and blood appear in the urine. Sometimes there is so much blood that the urine is red. This form of the disease has a good prognosis.

In almost 90-95% of cases, with adequate treatment, recovery occurs

If nephrotic syndrome occurs, then the likelihood of a favorable outcome is low. A clinic of this form has swelling, which first covers the lower extremities, later the face area, and in severe cases covers the entire body. A special feature is that the swelling moves well when palpated. Also, this syndrome is characterized by protein in the urine, but there is no blood or leukocytosis. In addition, the appearance changes. The child is pale, hair and nails become brittle and dull, skin very dry. No hypertension is observed.

Isolated urinary syndrome has only altered urine. The amount of protein increases, red blood cells are present. There are no other signs. In most cases, the disease becomes chronic.

The mixed variety includes the clinical picture of all the above syndromes.

Chronic glomerulonephritis

Chronic glomerulonephritis in children is diagnosed when pathological signs are present in the urine for more than six months, and hypertension and swelling do not go away with treatment for 12 months.

The nephrotic variant of the disease mainly affects young children. At the same time, during exacerbation, the child has persistent swelling and protein components in urine analysis.

Common symptoms include tearfulness, loss of appetite, and sleep disturbances.

If the form is mixed, then clinical picture symptoms of all types of glomerulonephritis appear (swelling, traces of blood and protein compounds in the urine, hypertension). The mixed version is very dangerous, often leads to kidney failure, and is difficult to cure.

The hematuric type of the disease has only urine pathology; it contains red blood cells and maybe some protein. It is considered the most optimal form in terms of outcome.

How to recognize the disease?

Diagnosis of the disease is based on a thorough history. Previous data is taken into account past illness, disturbances in the structure of the organ, heredity. Pediatrician and nephrologist should treat childhood glomerulonephritis.

A general blood and urine test is performed. A urine test according to Zimnitsky and the Reberg test are also prescribed. Important analysis is biochemical. It reflects an increase in creatinine, urea, nitrogenous bases, and antibodies to streptococcus. IN general analysis blood there is an increased level of leukocytes and erythrocyte sedimentation rate. As for the general urine test, it contains proteins, red blood cells, and maybe a certain number of casts. The amount of urine produced decreases.

Ultrasound of the kidneys shows a slight increase in size. Taking a biopsy sample is needed to determine the morphological form of the disease.

Acute glomerulonephritis in a child on ultrasound

An examination by a dentist, ophthalmologist and ENT doctor is mandatory in order to detect an infectious source.

How to treat?

Treatment of glomerulonephritis in children begins with compliance bed rest. The child should receive treatment only in a hospital setting. It is here that he will receive nursing care, which includes monitoring compliance with the doctor’s recommendations, monitoring changes in diuresis and edema. A diet must be followed, usually this is the seventh table according to Pevzner, at the beginning of the disease 7a, and with improvement, just the seventh. It eliminates salt consumption, limits fluid to seven hundred milliliters per day, and you need to eat in small portions. Protein is strictly limited. Therapeutic measures are selected taking into account the treatment protocol.

The group of sartans is used in older children to correct hypertension

Diuretics to combat edema (spironolactone, furosemide).

Hormones, most often prednisolone, to suppress inflammation in the glomerular system. Cytostatic drugs (levamisole, chlorbutin) are used less frequently; they are prescribed for extremely severe cases of glomerulonephritis.

To reduce tissue swelling and suppress the process, nonsteroidal anti-inflammatory drugs (nimesulide) and antiallergic drugs (loratadine) are also used.

How additional drug Canephron has proven itself well for the treatment of glomerulonephritis; it was created entirely on plant based. It has a diuretic, anti-inflammatory and bactericidal effect.

Medical examination of a child after illness

After recovery, it is necessary to constantly monitor the patient’s condition, because relapse of glomerulonephritis is a frequent phenomenon. If the child has suffered an acute form of the disease, then after discharge from the hospital he is transferred to a specialized sanatorium treatment. For the initial three months, he must monitor urine tests, monitor the absence of hypertension, and visit the doctor once every 2 weeks. Further, for nine months once a month. For the next 24 months, all of the above should be carried out once every 3 months. In addition, a person who has recovered from glomerulonephritis receives relief from physical culture, vaccinations are contraindicated for him for 12 months. Urine monitoring is mandatory if the child is sick colds. Such a child is released from observation if there are no cases of relapse for five years and pathological changes urine.

Preventive measures

Prevention includes timely, complete treatment of infection based on clinical recommendations. The course of prescribed medications must be completed in full. On days 10 and 21 after illness, general blood and urine tests must be taken.

Necessarily timely treatment carious teeth, which can be a source streptococcal infection

Prevent the development of foci of chronic infection in the child’s body. Beware of hypothermia and stress.

Conclusion

Glomerulonephritis requires a responsible attitude, because can lead to kidney failure, and subsequently the need for hemodialysis and a kidney transplant.

Chronic glomerulonephritis

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Glomerulonephritis is a bilateral inflammation of the kidneys with damage to the glomeruli. The chronic process is characterized by periods of exacerbation and remission. Often develops after acute nephritis (glomerulonephritis). Mostly men under 40 years of age are affected. There are many types of chronic forms of the disease (nephrotic, hypertensive, mixed, latent, etc.). All of them are diagnosed and play a role in prescribing treatment for chronic glomerulonephritis. Each type of glomerulonephritis has its own symptomatic features, but for a general diagnosis there are: general signs, by which the disease is determined. Detailed Clinical signs the doctor needs to know to determine the specific type of disease. Peculiarity chronic illness- the appearance of relapses, mainly in the autumn-spring period after hypothermia or infection.

Symptoms of glomerulonephritis

Symptoms of chronic glomerulonephritis increase gradually, but are mild. Most people do not notice any significant health problems at all, and the slow increase in shortness of breath and high blood pressure is not associated with kidney problems. Patients are concerned about shortness of breath, swelling of the legs and hypertension (persistent high blood pressure, in numbers - above 140/90). The chronic process is detected by urine tests. It is edema that in more than 80% of patients is characteristic feature chronic glomerulonephritis and appear before the onset of other symptoms. One of the signs is the so-called “nephritic face,” that is, a pale, swollen face.

Additional symptoms depending on the form of the disease:

The hypertensive form is characterized by disorders of the heart and blood vessels: vascular spasms, hypertension, nosebleeds, severe shortness of breath, visual impairment. Urinalysis changes slightly. This form occurs in every fifth patient.

Mixed form: constant swelling and high blood pressure, gradual increase in symptoms of chronic uremia. This form occurs in every tenth patient.

The subacute malignant form has pronounced signs of constant hypertension, persistent swelling, fever, brain damage (toxic substances from damaged kidneys enter the brain through the blood), heart failure; in blood - high cholesterol; uremia; symptoms increase rapidly. Patients with this form require urgent treatment.

Diagnosis of chronic glomerulonephritis is based on a variety of tests and a detailed survey. Important role The presence of acute nephritis in the past plays a role. After all diagnostic procedures a diagnosis is made, which will include the name of the form of the disease, characteristics of the kidneys and the presence/absence of an active process. Diagnostics include:

Ultrasound and X-ray;

blood analysis.

organization of the regime;
therapeutic nutrition;
symptomatic treatment;
stimulation of the immune system.

Chronic disease takes a long time to be treated; the specific duration of therapy depends on the severity and form. Symptomatic therapy includes drugs that reduce blood pressure, correct protein and acid composition blood (if necessary). Swelling is relieved with the help of diuretics. Since the disease affects the kidneys, a significant role is given to therapy that can restore impaired organ functions. The diet consists of eliminating alcohol, salt and limiting the consumption of liquids (salt and excessive consumption of liquids with impaired metabolism directly affect the development of edema and increased blood pressure). However, if there is significant renal failure, salt is limited slightly so as not to aggravate the disease. In each specific case of illness, the doctor assesses the patient’s condition and selects an individual diet and treatment regimen. If the patient's physical condition is satisfactory, moderate physical activity is indicated. As for the hospital stay, this period is short; the main phase of therapy takes place on an outpatient basis. The prognosis for timely treatment is generally favorable. After treatment, hypothermia and acute infections should be avoided. It is necessary to increase immunity and sanitize foci of chronic diseases (nasopharynx, tonsils).

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

In the renal glomerulus, the blood flow slows down, as through a semi-permeable membrane, the liquid part of the blood with electrolytes and organic substances dissolved in the blood seeps into Bowman’s capsule (which, like a wrapper, envelops the renal glomerulus on all sides). From the glomerulus, the cellular elements of blood with the remaining amount of blood plasma are excreted through renal vein. In the lumen of Bowman's capsule, the filtered part of the blood (without cellular elements) is called primary urine.

What is Bowman's capsule and renal tubules (loop of Henle)?

What happens to urine after it is filtered?

After filtration, the final urine is excreted through the renal tubule into the renal pelvis. Accumulating in it, urine gradually flows into the lumen of the ureters into bladder.

It is accessible and understandable about how the kidneys develop and work.

Three will be allowed classic symptoms: swelling, reddish urine and increased blood pressure, which may be accompanied by a headache or not bother the patient, determined only by measurement. The first appearance of these symptoms in young people is likely to lead to a diagnosis of acute glomerulonephritis. In old age, these changes in most cases will be attributed to primary chronic glomerulonephritis. Chronic glomerulonephritis is also diagnosed when acute glomerulonephritis exists within 12 months from the onset of the disease.

The diagnosis of rapidly progressive glomerulonephritis is usually made if, just a month and a half after the onset of the acute process, the density of urine decreases, nephrotic syndrome develops and blood pressure rises. This is accompanied by an increase in urea and creatinine in the blood.

Urine and blood tests and, if necessary, a kidney biopsy help confirm the diagnosis of glomerulonephritis. A general urine test reveals protein, a large number of red blood cells, casts (casts of renal tubules). Biochemical blood test for glomerulonephritis shows a decrease total protein and increasing its individual types.

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Ask your question to the doctor.

Kidney ultrasound is a common procedure for diagnosing diseases of the urinary system. Sometimes Ultrasound carried out for preventive purposes for early diagnosis possible diseases. In order to be able to distinguish kidney diseases from ultrasound images, it is necessary, first of all, to know the anatomy and normal ultrasound images of the kidneys. Kidney ultrasound has its own characteristics for different age periods, so ultrasound images are evaluated differently for children and adults.

Anatomy of the urinary system and kidneys

Normal and topographic anatomy form the basis of any research. To compare kidney ultrasound data and make a conclusion, you need to know the anatomical data, which is the norm. However, it is worth considering that the kidneys are an organ whose structure exhibits greatest number anatomical options.

In case of renal circulatory disorders, ultrasound reveals following signs acute renal failure:

the buds acquire a spherical shape;
the boundary between the cortex and medulla is sharply emphasized;
the kidney parenchyma is thickened;
the echogenicity of the cortex is increased;
Doppler examination reveals a decrease in blood flow velocity.

In acute renal colic, the kidney is also enlarged in size, but it is not the parenchyma that thickens, but the pyelocaliceal system. In addition, a stone in the form of a hyperechoic structure is detected in the kidney or ureters, which has caused the cessation of urine outflow.

Kidney injury on ultrasound. Concussion ( injury), renal hematoma on ultrasound

Kidney injury occurs when external force is applied to the lower back or abdomen due to a strong blow or compression. Kidney disease makes them even more susceptible to mechanical damage. Most often, kidney injuries are closed, which is why the patient may not be aware of internal bleeding when the kidneys rupture.

There are two types of kidney injuries:

Bruise ( contusion). With a bruise, there are no ruptures of the capsule, parenchyma or renal pelvis. Such damage usually passes without consequences.
Gap. When a kidney ruptures, the integrity of its tissues is compromised. Ruptures of the renal parenchyma lead to the formation of hematomas inside the capsule. In this case, blood can flow into urinary system and excreted in urine. In another case, when the capsule ruptures, blood along with primary urine flows into the retroperitoneal space. This is how the perinephric ( perirenal) hematoma.

Kidney ultrasound is the fastest and most accessible method for diagnosing kidney damage. In the acute phase, deformation of the contours of the kidneys, defects of the parenchyma and CL are detected. When a kidney ruptures, the integrity of the capsule is compromised. Anechoic areas are found within or near the capsule where blood or urine has accumulated. If some time passes after the injury, the hematoma acquires different characteristics on ultrasound. When blood clots and thrombi are organized in the hematoma, hyperechoic areas are observed against a general dark background. Over time, the hematoma resolves and is replaced by connective tissue.

The best diagnostic capabilities for injuries and hematomas are offered by computed tomography and magnetic resonance imaging. Treatment of hematomas with a volume of up to 300 ml is carried out conservatively. Sometimes percutaneous puncture of hematomas can be performed under ultrasound guidance. Only in 10% of cases with heavy internal bleeding, surgical intervention is performed.

Chronic renal failure ( chronic renal failure) on ultrasound

Chronic renal failure is pathological decline kidney function as a result of nephron death ( functional renal units). Chronic kidney failure is the outcome of most chronic kidney diseases. Since chronic diseases are asymptomatic, the patient considers himself healthy until the onset of uremia. In this condition, severe intoxication of the body occurs with those substances that are usually excreted in the urine ( creatinine, excess salts, urea).

The causes of chronic renal failure are the following diseases:

chronic pyelonephritis;
chronic glomerulonephritis;
urolithiasis disease;
arterial hypertension ;
diabetes;
polycystic kidney disease and other diseases.

In renal failure, the volume of blood filtered by the kidneys per minute decreases. Normally, the glomerular filtration rate is 70–130 ml of blood per minute. The patient's condition depends on the decrease in this indicator.

The following degrees of severity of chronic renal failure are distinguished depending on the glomerular filtration rate ( SCF):

Easy. GFR ranges from 30 to 50 ml/min. The patient notices an increase in nighttime urine output, but nothing else bothers him.
Average. GFR ranges from 10 to 30 ml/min. Daily urination increases and constant thirst appears.
Heavy. GFR less than 10 ml/min. Patients complain about constant fatigue, weakness, dizziness. Nausea and vomiting may occur.

If you suspect chronic renal failure An ultrasound of the kidneys is always performed to determine the cause and treat the underlying disease. The initial sign On ultrasound, indicating chronic renal failure is a decrease in the size of the kidney and thinning of the parenchyma. It becomes hyperechoic, and the cortex and medulla are difficult to distinguish from each other. At late stage CRF observed nephrosclerosis ( shriveled bud). In this case, its dimensions are about 6 centimeters in length.

Signs of a wrinkled kidney ( nephrosclerosis) on ultrasound. Retraction of the renal parenchyma

The term "shrinked bud" ( nephrosclerosis) describes a condition in which kidney tissue is replaced by connective tissue. Many diseases cause destruction of the kidney parenchyma, and the body is not always able to replace dead cells with identical ones. Human body does not tolerate emptiness, therefore, with massive cell death, regeneration occurs and they are replenished with connective tissue cells.

Connective tissue cells produce fibers that, when attracted to each other, cause a decrease in the size of the organ. In this case, the organ shrinks and ceases to function fully.

At acute inflammation the kidneys increase in size, and hypoechoic swelling of the tissue around the organ forms. Chronic infection gradually leads to a decrease in kidney size. Accumulations of pus appear as hypoechoic areas. When there is inflammation in the kidney, blood flow may change. This is clearly visible on duplex ultrasound using Doppler mapping.

In addition to ultrasound, contrast contrast is used to visualize inflammatory processes in the kidneys. X-ray examination, computed and magnetic resonance imaging ( CT and MRI). If some areas of the kidneys are inaccessible for examination on x-rays, then tomography allows you to obtain a detailed image of the kidneys. However, there is not always time and appropriate conditions to perform CT and MRI.

Acute pyelonephritis on kidney ultrasound

Pyelonephritis is an infectious and inflammatory disease of the kidneys. In pyelonephritis, the renal parenchyma and collecting tubule system are affected. With this disease, the infection enters the kidney ascendingly through the ureters. Often acute pyelonephritis becomes a complication of cystitis - inflammation of the bladder. Pyelonephritis is caused mainly by opportunistic microflora ( coli) and staphylococci. Depending on its course, pyelonephritis can be acute or chronic.

Symptoms of acute pyelonephritis are:

fever, fever, chills;
pain in the lumbar region;
urinary disturbance ( decreased amount of urine).

Diagnosis of acute pyelonephritis is based on a blood test, urine test, and ultrasound. The best method Diagnosis of acute pyelonephritis is computed tomography.

Signs of acute pyelonephritis on kidney ultrasound are:

an increase in the size of the kidneys more than 12 cm in length;
decreased kidney mobility ( less than 1 cm);
deformation of the medulla with the formation of accumulations of serous fluid or pus.

If on an ultrasound scan of the kidneys, in addition to the listed symptoms, there is an expansion of the pyelocaliceal system, then this indicates obstruction ( blocking) urinary tract. This condition requires urgent surgical intervention. Acute pyelonephritis with proper treatment passes quickly. This requires taking antibiotics. However, with incorrect treatment tactics or late consultation with a doctor, kidney tissue forms purulent abscesses or carbuncles that require surgery to treat.

Kidney carbuncle on ultrasound. Kidney abscess

Kidney carbuncle and abscess are severe manifestations of acute purulent pyelonephritis. They represent limited infectious process in the kidney parenchyma. When an abscess forms, microorganisms enter the kidney tissue through the blood or ascending the urinary tract. An abscess is a cavity surrounded by a capsule, inside which pus accumulates. On ultrasound, it appears as a hypoechoic area in the renal parenchyma with a bright hyperechoic rim. Sometimes with an abscess there is an expansion of the pyelocaliceal system.

A kidney carbuncle is more severe than an abscess. Carbuncle is also caused by the proliferation of microorganisms in the kidney tissue. However, in the mechanism of carbuncle development, the vascular component plays the main role. When microorganisms enter a vessel, they block its lumen and stop blood supply. In this case, the death of kidney cells occurs due to lack of oxygen. After thrombosis and heart attack ( vascular necrosis ) the renal wall is followed by its purulent melting.

With a kidney carbuncle on ultrasound, the organ is enlarged and its structure is locally deformed. The carbuncle looks like a volumetric formation of high echogenicity with fuzzy outlines in the kidney parenchyma. In the center of the carbuncle there are hypoechoic areas corresponding to the accumulation of pus. In this case, there are usually no changes in the pyelocaliceal structure. Carbuncle and kidney abscess are treated surgically with the mandatory use of antibiotics.

Chronic pyelonephritis on kidney ultrasound

Chronic pyelonephritis differs from acute pyelonephritis in its long course and tendency to exacerbations. This disease is characterized by the persistence of foci of infection in the kidney tissue. It occurs due to a violation of the outflow of urine. We're guilty of this hereditary factors and acquired conditions ( for example, urolithiasis). With each exacerbation, chronic pyelonephritis affects more and more areas of the parenchyma, which is why the entire kidney gradually becomes non-functional.

Chronic pyelonephritis has several phases changing each other in its course:

Active phase. This phase proceeds similarly to acute pyelonephritis and is characterized by severe pain, malaise, and difficult urination.
Latent phase. The patient is bothered by rare painful sensations in the lower back, while bacteria are always present in the urine.
Remission phase. It is a condition in which the disease does not manifest itself in any way, however, with a decrease in immunity, it can suddenly worsen.

As with others destructive diseases In chronic pyelonephritis, the destroyed parenchyma is replaced by scar tissue. This gradually leads to kidney failure. In this case, the kidney takes on a wrinkled appearance, as the fibers of the connective tissue are pulled together over time.

Signs of chronic pyelonephritis on kidney ultrasound are:

Expansion and deformation of the pyelocaliceal system. It becomes rounded, and the cups merge with the pelvis.
Reduction in the thickness of the kidney parenchyma. The ratio of the kidney parenchyma to the pyelocaliceal system becomes less than 1.7.
Reduction in kidney size uneven outline edges of the bud. This deformation indicates a long process and wrinkling of the kidney.

Glomerulonephritis on kidney ultrasound

Glomerulonephritis is an autoimmune lesion of the vascular glomeruli of the kidneys located in the renal cortex. The glomeruli are part of the nephron, the functional unit of the kidney. It is in the vascular glomeruli that blood filtration and the initial stage of urine formation occur. Glomerulonephritis is the main disease leading to chronic renal failure. When 65% of nephrons die, signs of renal failure appear.

Symptoms of glomerulonephritis are:

increased blood pressure;
swelling;
red coloration of urine ( presence of red blood cells);
lower back pain.

Glomerulonephritis, like pyelonephritis, is an inflammatory disease. However, with glomerulonephritis, microorganisms play a secondary role. In glomerulonephritis, the glomeruli are affected due to a malfunction in the immune mechanisms. Glomerulonephritis is diagnosed using a biochemical test of blood and urine. An ultrasound of the kidneys with Doppler examination of renal blood flow is mandatory.

IN initial stage Glomerulonephritis on ultrasound shows the following signs:

increase in kidney volume by 10 - 20%;
a slight increase in the echogenicity of the kidneys;
increased blood flow velocity in the renal arteries;
clear visualization of blood flow in the parenchyma;
symmetrical changes in both kidneys.

In the late stage of glomerulonephritis, the following changes in the kidneys on ultrasound are characteristic:

a significant decrease in the size of the kidneys, up to 6 – 7 cm in length;
hyperechogenicity of kidney tissue;
inability to distinguish between the renal cortex and medulla;
decrease in blood flow velocity in the renal artery;
depletion of the bloodstream inside the kidney.

The outcome of chronic glomerulonephritis in the absence of treatment is nephrosclerosis - a primarily shriveled kidney. Anti-inflammatory drugs and medications that reduce immune responses are used to treat glomerulonephritis.

Renal tuberculosis on ultrasound

Tuberculosis is a specific disease caused by mycobacterium. Kidney tuberculosis is one of the most common secondary manifestations of this disease. The primary focus of tuberculosis is the lungs, then Mycobacterium tuberculosis enters the kidneys through the bloodstream. Mycobacteria multiply in the glomeruli of the renal medulla.

With tuberculosis in the kidneys, the following processes are observed:

Infiltration. This process means the accumulation of mycobacteria in the cortex and medulla with the formation of ulcers.
Tissue destruction. The development of tuberculosis leads to the formation of zones of necrosis, which look like rounded cavities.
Sclerosis ( connective tissue replacement). The vessels and functional cells of the kidneys are replaced by connective tissue. This protective reaction leads to impaired renal function and kidney failure.
Calcification ( calcification). Sometimes foci of mycobacteria multiplication turn into stone. This protective reaction of the body is effective, but does not lead to a complete cure. Mycobacteria can regain activity again when immunity decreases.

A reliable sign of kidney tuberculosis is the detection of kidney mycobacteria in the urine. Using ultrasound, you can determine the degree of destructive changes in the kidneys. Cavities in the kidney tissue are found in the form of anechoic inclusions. Stones and areas of calcification accompanying renal tuberculosis look like hyperechoic areas. Duplex ultrasound of the kidneys reveals narrowing of the renal arteries and decreased renal circulation. For a detailed study of the affected kidney, computed tomography and magnetic resonance imaging are used.

Anomalies of the structure and position of the kidneys on ultrasound. Kidney diseases accompanied by the formation of cysts

Kidney anomalies are abnormalities caused by abnormal embryonic development. For one reason or another, anomalies genitourinary system are the most common. It is believed that about 10% of the population has various kidney abnormalities.

Kidney abnormalities are classified as follows:

Abnormalities of the renal vessels. They consist of changing the trajectory, the number of renal arteries and veins.
Abnormalities in the number of kidneys. There have been cases where a person had 1 or 3 kidneys. Separately, the anomaly of kidney duplication is considered, in which one of the kidneys is divided into two practically autonomous parts.
Abnormalities in kidney size. The kidney may be reduced in size, but there are no cases of congenital enlarged kidneys.

Abnormalities of the kidneys. The kidney may be located in the pelvis, near the iliac crest. There are also cases when both kidneys are located on the same side.
Abnormalities of the kidney structure. Such anomalies consist of underdevelopment of the renal parenchyma or the formation of cysts in the renal tissue.

Diagnosis of kidney abnormalities first becomes possible when performing an ultrasound of the newborn’s kidneys. Most often, kidney abnormalities are not serious reason for concern, but lifelong kidney monitoring is recommended. For this, x-rays, computed tomography and magnetic resonance imaging can be used. It is necessary to understand that kidney abnormalities in themselves are not diseases, but they can provoke their appearance.

Duplication of the kidneys and pyelocaliceal system. Signs of kidney duplication on ultrasound

Kidney doubling is the most common anomaly kidney It occurs in women 2 times more often than in men. Duplication of the kidneys is explained by a congenital anomaly of the germ layers of the ureters. Doubled buds are conventionally divided into top part and lower, of which the upper bud is usually less developed. Doubling differs from an additional bud in that both parts are tied friend with each other and are covered with one fibrous capsule. The accessory kidney is less common, but has its own blood supply and capsule. Kidney duplication can be complete or incomplete.

Kidney duplication can be of two types:

Full doubling. With this type of duplication, both parts have their own pyelocaliceal system, artery and ureter.
Incomplete doubling. It is characterized by the fact that the ureters of both parts unite before emptying into the bladder. Depending on the degree of development of the upper part, it may have its own artery and pyelocaliceal system.

On ultrasound double kidney is easily determined, since it has all structural elements normal kidney, but in double quantity. Its components are located one above the other inside one hyperechoic capsule. When the CLS is doubled in the hilum area, two characteristic hypoechoic formations. Double kidneys do not require treatment, but with this anomaly the risk of various diseases increases, such as pyelonephritis and urolithiasis.

Underdevelopment ( hypoplasia, dysplasia) kidneys on ultrasound

Underdevelopment of the kidneys can occur in two ways. One of them is hypoplasia - a condition in which the kidney is reduced in size, but functions as well as normal kidney. Another option is dysplasia. This term refers to a condition in which the kidney is not only reduced in size, but also structurally defective. With dysplasia, the parenchyma and CL of the kidneys are significantly deformed. In both cases, the kidney on the opposite side is enlarged to compensate for the functional deficiency of the underdeveloped kidney.

With renal hypoplasia, ultrasound reveals a smaller organ. Its length on ultrasound is less than 10 centimeters. Ultrasound can also determine the function of an underdeveloped kidney. In a functioning kidney, the arteries have a normal width ( 5 mm at the gate), and the pyelocaliceal system is not dilated. However, with dysplasia the opposite picture is observed.

Signs of kidney dysplasia on ultrasound are:

expansion of the maxillofacial area of more than 25 mm in the area of the pelvis;
reduction in parenchyma thickness;
narrowing of the renal arteries;
narrowing of the ureters.

Kidney prolapse ( nephroptosis) on ultrasound. Wandering buds

Nephroptosis is a condition in which the kidney moves down from its bed when the body position changes. Normally, the movement of the kidneys during their transition from vertical to horizontal position does not exceed 2 cm. However, due to various factors (injuries, excessive physical activity, muscle weakness ) the kidney may acquire pathological mobility. Nephroptosis occurs in 1% of men and about 10% of women. In cases where the kidney can be moved by hand, it is called a wandering kidney.

Nephroptosis has three degrees:

First degree. When inhaling, the kidney partially moves down from the hypochondrium and is palpated, and returns back during exhalation.
Second degree. IN vertical position the kidney completely emerges from the hypochondrium.
Third degree. The kidney descends below the iliac crest into the pelvis.

Nephroptosis is dangerous because when the position of the kidneys changes, vascular tension occurs, blood circulation is impaired and the kidneys swell. Stretching of the kidney capsule causes pain. When the ureters are deformed, the outflow of urine is disrupted, which threatens expansion renal pelvis. A common complication of nephroptosis is the addition of infection ( pyelonephritis). The listed complications are almost inevitable with the second or third degree of nephroptosis.

Ultrasound reveals nephroptosis in most cases. The kidney may not be detected on a routine scan in the upper lateral abdomen. If renal prolapse is suspected, an ultrasound scan is performed in three positions - lying, standing and on the side. The diagnosis of nephroptosis is made in the case of an abnormally low position of the kidneys, their great mobility when changing body position or when breathing. Ultrasound also helps identify complications caused by changes in the position of the kidneys.

Kidney cyst on ultrasound

A cyst is a cavity in the kidney tissue. It has an epithelial wall and a fibrous base. Kidney cysts can be congenital or acquired. Congenital cysts develop from cells of the urinary tract that have lost connection with the ureters. Acquired cysts form at the site of pyelonephritis, kidney tuberculosis, tumors, heart attack, as a residual formation.

A kidney cyst usually does not manifest clinical symptoms and is detected incidentally during ultrasound examination. When the kidney size is up to 20 mm, the cyst does not cause compression of the parenchyma and functional disorders. A cyst larger than 30 mm is an indication for puncture.

On a kidney ultrasound, the cyst appears as a round, black, anechoic formation. The cyst is surrounded by a hyperechoic rim of fibrous tissue. The cyst may contain dense areas that are blood clots or fossils. The cyst may have septa, which are also visible on ultrasound. Multiple cysts are not so common; they need to be differentiated from polycystic kidney disease, a disease in which the kidney parenchyma is almost completely replaced by cysts.

When performing an ultrasound with a water or diuretic load, the size of the cyst does not change, in contrast to the pyelocaliceal system, which expands when this study. On color Doppler imaging, the cyst does not produce color signals because there is no blood supply to its wall. If vessels are found around the cyst, this indicates its degeneration into a tumor.

Puncture of cysts using ultrasound guidance

Ultrasound examination is indispensable for the treatment of kidney cysts. Using ultrasound, the size and position of the cyst and its accessibility for puncture are assessed. Under control ultrasound image A special needle is inserted through the skin and fixed to the puncture sensor. The location of the needle is checked by the image on the screen.

After the wall of the cyst is punctured, its contents are removed and examined in the laboratory. The cyst may contain serous fluid, urine, blood, or pus. Then a special liquid is injected into the cyst cavity. It destroys the epithelium of the cyst and resolves over time, causing the cyst cavity to be replaced with connective tissue. This method of treating cysts is called sclerotherapy.

For the treatment of cysts up to 6 cm in diameter, cyst sclerotherapy is effective. In case of certain positions of the cysts or their large sizes, only surgical removal of the cysts is possible.

Polycystic kidney disease on ultrasound

Polycystic disease is congenital disease kidney Depending on the type of inheritance, it can manifest itself in childhood or in adults. Polycystic disease is genetic disease, so he is not cured. The only treatment for polycystic disease is kidney transplantation.

For polycystic disease genetic mutation leads to disruption of the fusion of nephron tubules with the primary collecting ducts. Because of this, multiple cysts form in the cortex. Unlike simple cysts, with polycystic disease the entire cortex is gradually replaced by cysts, causing the kidney to become nonfunctional. In polycystic disease, both kidneys are affected equally.

On ultrasound, the polycystic kidney is enlarged in size and has a lumpy surface. In the parenchyma, multiple anechoic formations are found that are not connected to the pyelocaliceal system. The cavities on average range in size from 10 to 30 mm. In newborns with polycystic kidney disease, a narrowing of the chest and an empty bladder are characteristic.

Medullary spongy kidney on kidney ultrasound

This disease is also congenital pathology, however, unlike polycystic cysts, cysts are formed not in the cortex, but in the medulla. Due to deformation of the collecting ducts of the pyramids, the kidney becomes like a sponge. The cyst cavities in this pathology range in size from 1 to 5 mm, that is, much smaller than in polycystic disease.

The medullary spongy kidney functions normally for a long time. Unfortunately, this disease is a provoking factor for urolithiasis and infections ( pyelonephritis). In this case, there may be unpleasant symptoms in the form of pain, urination problems.

On ultrasound, a medullary spongy kidney is usually not detected, since there are no ultrasound machines with a resolution greater than 2–3 mm. With medullary spongy kidney, the cysts are usually smaller. A decrease in the echogenicity of the renal medulla may be suspected.

Excretory urography is used to diagnose this disease. This method relates to x-ray diagnostics. At excretory urography monitor the filling of the urinary tract with a radiopaque substance. Medullary kidney characterized by the formation of a “bouquet of flowers” in the medulla on excretory urography.

Before use, you should consult a specialist.

Doctors have a saying that “jade doesn’t hurt.” Unfortunately, kidney diseases, which are often complications of acute respiratory viral infections, tonsillitis, scarlet fever, and other infections, are mild or asymptomatic. Glomerulonephritis is especially dangerous - glomerular nephritis, leading to disability.

Appointment with a urologist - 1000 rubles. Comprehensive ultrasound kidneys - 1000 rub. Admission based on test results - 500 rubles. (optional)

What is glomerulonephritis

Glomerulonephritis (GN) is an inflammation of the kidneys that affects the glomeruli (glomeruli), tubules and interstitial (connective) tissue of the kidneys. This is an immune disease, so it is very difficult to treat.

Glomerulonephritis can be an independent disease or associated with systemic diseases- infective endocarditis, hemorrhagic vasculitis, lupus erythematosus, etc.

The disease remains asymptomatic for a long time. When the patient realizes that something is wrong with the kidneys and consults a doctor, it turns out that the affected organs cannot cope with their function. The situation leads to disability, condemning a person to lifelong attachment to an artificial kidney machine or to waiting for a donor for an organ transplant. This can be avoided if after past infection visit a urologist, And .

Risk group

Acute glomerulonephritis affects people of any age, but the disease is more common in young patients under 40 years of age. The disease ranks 2nd among complications of urinary tract infections in children.

According to statistics, glomerulonephritis is the most common reason early disability due to the development of renal failure.

The disease is especially severe in pregnant women. Since during pregnancy the urinary system carries increased load, women planning to have a child are recommended to undergo an ultrasound of the kidneys to exclude hidden nephritis.

Why does glomerulonephritis occur: there are many reasons

The cause of glomerulonephritis is acute or chronic streptococcal and other infections: ARVI, pneumonia, measles, tonsillitis, scarlet fever, tonsillitis, streptoderma (skin infection), chicken pox. If the primary infection is supplemented by hypothermia or exposure to a damp climate (trench nephritis), then the likelihood of a severe complication increases several times. This is due to a glitch immunological reactions leading to impaired blood supply to the kidneys.

Urologists note a connection between glomerulonephritis and (Toxoplasma gondii), meningitis (Neisseria meningitidis), staphylococcus ( Staphylococcus aureus). After an outbreak of streptococcal infection, glomerulonephritis occurs within 1-3 weeks in 10-15% of patients. It is especially often caused by nephritogenic strains of b-hemolytic streptococcus A.

In response to the introduction of foreign microorganisms into the body, the body produces substances to destroy them. But sometimes for unknown reasons the immune system malfunctions, taking on foreign substances in kidney cells. An inflammatory process occurs, accompanied by tissue damage and impaired urine filtration. Microscopic blood clots form inside the renal vessels.

Blood appears in the urine (hematuria). Sometimes there is so much of it that the urine looks like meat slop. But more often, little blood is released, and it can only be detected using laboratory methods.

Symptoms of glomerulonephritis

There are two forms of the disease: acute and chronic. Acute glomerulonephritis gives more vivid symptoms, while chronic glomerulonephritis is practically unnoticeable for a long time. Urologists note that the disease manifests itself more clearly in children than in adults.

Acute glomerulonephritis

The acute form gives at least three groups of symptoms:

(micro- or macrohematuria, oliguria);
swelling;
hypertensive signs.

Two variants of the course are possible: typical (cyclic) with vivid symptoms and latent (acyclic) glomerulonephritis is expressed by a gradual onset and erased symptoms. Acyclic is dangerous due to late diagnosis. It is this that often develops into chronic glomerulonephritis.

In the acute form of the disease, the patient's temperature rises, weakness, nausea and lower back pain appear. A characteristic symptom of the disease is swelling, especially in the face and neck. Swelling appears in the morning and gradually goes away during the day. The amount of urine produced decreases and becomes reddish in color.

But, more often than not, the symptoms of the disease remain vague. Small increase people attribute fever and weakness to recent past illness. Swelling is also not always pronounced. Gain of 3-4 kg by an adult, especially those suffering overweight, often goes unnoticed, and the faint reddish tint of urine also does not arouse suspicion.

Jade does not cause intense pain, only a slight heaviness in the lower back. Therefore, people often do not go to the doctor, and the disease develops into chronic form.

In 60% of patients, blood pressure begins to periodically increase, which is not reduced by conventional antihypotensive drugs. And 85% have problems with the functioning of the heart and blood vessels. Therefore, patients often do not come , but to a cardiologist or therapist. Nephritis is detected only after tests and ultrasound of the kidneys are prescribed.

Chronic glomerulonephritis

Chronic glomerulonephritis gives 2 groups of symptoms:

nephrotic signs (urinary problems);
hypertensive symptoms.

Not unusual mixed type syndromes - hypertensive plus nephrotic.

Also, as with the acute form, a latent course and hematuric type of the disease are possible, when the urine contains red blood cells, and other symptoms are practically invisible.

All forms of glomerulonephritis recur, especially often in the spring and autumn after a streptococcal infection.

Complications and prognosis for cure

In severe cases, nephritis progresses rapidly, causing accompanied by severe swelling. Impaired kidney function leads to poisoning of the body with unresolved toxins. Problems arise with the functioning of other organs - the heart, liver, brain.

Undiagnosed and untreated glomerulonephritis becomes chronic and leads to renal failure. The kidneys shrink, decrease in size, and cannot fully perform their function.

If the disease is not treated, you can get:

acute renal failure (in 1% of cases);
acute heart failure (2-3%);
intracerebral hemorrhage and visual impairment;
preeclampsia, eclampsia (acute renal encephalopathy);
chronic glomerulonephritis.

With timely contact with an experienced urologist, the symptoms of acute glomerulonephritis - edema and arterial hypertension - disappear within 2-3 weeks. For a complete recovery, you will have to undergo treatment for at least 2 months.

How is glomerulonephritis diagnosed?

The diagnosis of “acute glomerulonephritis” is made based on several factors:

Postponed infection in the anamnesis;
Clinical manifestations - high blood pressure, swelling, urination disorders;
Laboratory data.

The urologist evaluates urinary, edematous and hypertensive syndromes.

Patients submit:

(Zimnitsky and Rehberg samples), in which protein and traces of blood are detected. The analysis reveals clotted cylinders consisting of coagulated protein and other components. These are a kind of “casts” of the kidney tubules, washed with urine. An important symptom is micro- or macrohematuria, when the urine changes color to almost black. At the first stage of the disease, fresh red blood cells are found in the urine, followed by leaching. The Zimnitsky test shows nocturia, decreased diuresis and high relative density of urine.
Blood from a finger, in which an increase in the level of leukocytes and an acceleration of ESR are diagnosed. These changes indicate an inflammatory process.
. With glomerulonephritis, a sharp increase is detected residual nitrogen, indicating weak kidney function. An increase in the concentration of cholesterol, creatinine, ALT and AST is diagnosed.

The urologist prescribes an ultrasound of the kidneys and an ultrasound scan of the renal vessels. A kidney biopsy may be ordered to confirm the diagnosis.

What does a kidney ultrasound show for glomerulonephritis?

Ultrasound shows the beginning picture of renal sclerosis - the contours of the kidneys lose clarity, and their tissue becomes dense due to inflammation. The pyramids through which excreted urine enters the collecting system look too dark (hypoechoic).

As the disease progresses, the kidneys shrink. Normally their size is:

length – 10.5-11 mm;
width – 4.5-5 mm;
the thickness of the parenchyma - the substance that makes up the organ - is 1.5-2.5 cm.

With degenerative changes that accompany glomerulonephritis, the kidney tissue shrinks. The kidney becomes uneven with areas of retraction. A layer of calcium salts is deposited around the pyramids that filter urine, which looks like a white rim on ultrasound.

The longer the disease lasts, the smaller the kidneys become. Their contours are completely “blurred” and the organs become difficult to recognize against the background of the surrounding tissue. The internal renal structures become completely indistinguishable.

The blood supply to the organ is also disrupted, visible on ultrasound and Doppler, as a depletion of the vascular pattern and a general decrease in blood flow.

Treatment of glomerulonephritis

The disease, especially when diagnosed late, takes a long time and is difficult to treat. The patient is prescribed anti-inflammatory drugs, antibiotics, and hormones. During treatment, it is important to adhere to strict salt-free diet. An indicator of treatment success is improvement general condition, normalization of laboratory parameters and disappearance of signs of acute inflammation on ultrasound.

Unfortunately, glomerulonephritis, especially chronic, often recurs after another cold or simply in the off-season. Therefore, people suffering from it need to be periodically tested and undergo .

If an ultrasound shows that degenerative changes in the kidneys have stopped, we can assume that the person has overcome an unpleasant disease.

Where to get a kidney ultrasound and be checked for glomerulonephritis in St. Petersburg

In St. Petersburg, such an examination is performed at the specialized urological clinic Diana. The cost of an ultrasound scan of the kidneys and adrenal glands is only 1000 rubles. Ultrasound diagnostics is performed on an expert device latest generation. Here you can get advice from an experienced urologist and undergo any tests.